﻿<!DOCTYPE html>
<html lang="en">
<#include "../include/resource-head.ftl"/>
<#assign active='ld'/>
<body>
<#include "../include/common-top.ftl"/>
<div class="main-container" id="main-container">
    <div class="main-container-inner">
    <#include "../include/common-menu.ftl"/>
        <div class="main-content">
            <div class="page-content">
                <div class="col-xs-12">
                    <div class="row-fluid">
                        <div class="widget-box">
                            <div class="widget-header widget-header-blue widget-header-flat">
                                <h4 class="lighter">
                                    <i class="icon-plus"></i>生活档案修改
                                </h4>
                            </div>
                            <div class="widget-body">
                                <div class="widget-main">
                                    <div class="step-content row-fluid position-relative">
                                        <form class="form-horizontal" action="/life/update" method="post">
                                            <#if life??>
                                                <input type="hidden" name="id" value="${life.id!}">
                                            </#if>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">吸烟</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="xy" value="是" <#if (life.xy!'') != '否' >checked</#if>>是
                                                    <input type="radio" name="xy" value="否" <#if (life.xy!'') == '否' >checked</#if>>否
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">酗酒</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="xj" value="是" <#if (life.xj!'') != '否' >checked</#if>>是
                                                    <input type="radio" name="xj" value="否" <#if (life.xj!'') == '否' >checked</#if>>否
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">最近旅行城市</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="lycs"
                                                           value="${life.lycs!}" required/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">月经周期</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="number" class="width-100" name="yjzq"
                                                           value="${life.yjzq!28}" required/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">结合病史</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="zhbs"
                                                           value="${life.zhbs!}" placeholder="没有可不填"/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">疫苗接种历史</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="ymjz"
                                                           value="${life.ymjz!}" placeholder="没有可不填"/>
                                                </div>
                                            </div>

                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">居住城市</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="text" class="width-100" name="jzcs"
                                                           value="${life.jzcs!}" placeholder="没有可不填"/>
                                                </div>
                                            </div>


                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">饮用饮料习惯</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="yyyy" value="几乎不"
                                                           <#if (life.yyyy!'几乎不') == '几乎不' >checked</#if>>几乎不
                                                    <input type="radio" name="yyyy" value="偶尔"
                                                           <#if (life.yyyy!'') == '偶尔' >checked</#if>>偶尔
                                                    <input type="radio" name="yyyy" value="经常"
                                                           <#if (life.yyyy!'') == '经常' >checked</#if>>经常
                                                </div>
                                            </div>


                                            <div class="form-group has-info">
                                                <label class="col-xs-12 col-sm-5 control-label no-padding-right">饮食习惯</label>
                                                <div class="col-xs-12 col-sm-5">
                                                    <input type="radio" name="ysxg" value="重口"
                                                           <#if (life.ysxg!'重口') == '重口' >checked</#if>>重口
                                                    <input type="radio" name="ysxg" value="清淡"
                                                           <#if (life.ysxg!'') == '清淡' >checked</#if>>清淡
                                                    <input type="radio" name="ysxg" value="适中"
                                                           <#if (life.ysxg!'') == '适中' >checked</#if>>适中
                                                </div>
                                            </div>


                                            <hr/>
                                            <div class="row-fluid wizard-actions">
                                                <button class="btn btn-info" type="button"
                                                        onclick="javascript:history.go(-1)">返回
                                                </button>
                                                <button class="btn" type="reset">重置</button>
                                                <button class="btn btn-success" type="submit">提交</button>
                                            </div>


                                        </form>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div><!-- /.page-content -->
    </div><!-- /.main-content -->
</div><!-- /.main-container -->
</body>
<#include "../include/resource-script.ftl"/>
</html>

